Indian Health Service (IHS) hospitals and tribally operated facilities provide care in some of the most rural and resource-constrained regions of the United States. The IHS system spans federally run hospitals, tribally managed facilities, and urban Indian health programs. Surgical capacity is uneven: some hospitals can provide standard procedures like orthopedics or ophthalmology, while others must refer patients out through the Purchased/Referred Care (PRC) program. This structure ensures access but also creates operational challenges around scheduling, documentation, and funding.
The Realities of Surgical Care in IHS
Not every IHS facility can sustain a full-service OR program. A small tribal hospital might run one or two operating rooms, staffed by a lean team that wears multiple hats. Visiting specialists may only be available one day a week, and when cases can’t be done locally, PRC funds are used to send patients to outside hospitals.
One Perioperative Nurse from the Northern Plains put it this way:
“When our visiting Ortho comes in, we try to move mountains to fit everyone in. If we miss a case, that patient might be waiting another month or traveling four hours to another hospital.”
Funding shapes every decision. Studies have shown that per-person spending in IHS is far lower than in Medicare, Medicaid, or the VA. That gap directly affects technology investments, staffing depth, and the ability to expand surgical services. For perioperative leaders, the challenge is clear: every saved minute and every avoided duplication matters.
Why Efficiency and Accuracy Matter So Much
For IHS hospitals, the margin for error is razor-thin. With only one or two operating rooms, an idle OR isn’t just inconvenient; it’s a lost opportunity to care for another patient who may have traveled hours to get there. A turnover that drags on for 40 minutes instead of 20 can mean one fewer surgery completed that day.
Documentation presents another hurdle. Patients often bounce between IHS facilities, outside specialists, and back to their tribal primary care provider. If records aren’t captured cleanly and travel seamlessly, details get lost. That incomplete anesthesia note, or unclear med list, can set off a chain of delays or even force another referral.
Staffing makes the situation even more complex. Teams are lean and cross-trained, with nurses, techs, and anesthesia providers juggling multiple roles. The more standardized and reliable the workflow, the less it matters who’s on shift that day; everyone can follow the same playbook.
And then there’s the question of data. In an extensive health system, leaders can track dozens of KPIs. However, in a resource-constrained IHS hospital, a handful of metrics really make the difference: whether the first case starts on time, how long it takes to complete turnovers, and how often patients need to be referred out. With the correct data, leaders can make smart calls about where to focus scarce resources.
Practical Role of Perioperative Software
Platforms like Picis OR Manager, Anesthesia Manager, and SmarTrack Next focus on the nuts and bolts of perioperative operations: scheduling, supply management, anesthesia documentation, and near real-time patient tracking. For IHS facilities, the point isn’t fancy dashboards. It’s fewer handoffs lost to paper, smoother turnovers, and cleaner documentation for referrals.
Picis brings relevant experience, having supported the Department of Veterans Affairs (VA) and other government entities. That history matters because federal facilities often share the same demands for compliance, interoperability, and governance.
Scenarios That Hit Home
Visiting specialist day. A tribal hospital in the Southwest hosts an orthopedic surgeon once a week. With only two ORs and limited staff, every turnover counts. Using a live tracking system, the team can see which room is ready and avoid downtime. Anesthesia data flows automatically, so the nurse isn’t stuck double-charting vitals. The result: six joints were completed instead of four, and two patients were spared referral delays.
Referral readiness. When complex cases must go out, time is often lost assembling the referral packet. With perioperative documentation structured and complete, facilities can send full records, including vitals, medication lists, allergies, and anesthesia assessments, without retyping. That reduces back-and-forth with outside hospitals and speeds patient acceptance.
Supply visibility. In small, remote hospitals, a single missing implant tray can cancel a case. Software that tracks inventory against scheduled procedures reduces last-minute cancellations, saving scarce PRC funds and patient frustration.
Aligning With Broader IHS Trends
Purchased/Referred Care (PRC) funds are finite and prioritized for emergencies, so anything that keeps routine cases in-house helps stretch budgets. In addition, some rural hospitals are transitioning to the Rural Emergency Hospital (REH) designation, focusing on emergency and outpatient care. For these facilities, streamlined surgical scheduling, accurate documentation, and strong referral workflows become even more critical.
A Lightweight Roadmap for IHS Surgical Teams
Improving perioperative workflows doesn’t always mean big technology projects. Sometimes it’s about tightening the basics.
Start by mapping out the day. Where are the actual bottlenecks? Is it the first case that slips because a patient isn’t ready? Are the turnovers stretching too long? Or is it PACU beds filling up before cases finish? Understanding the actual pinch points is the foundation for change.
From there, focus on handoffs. When patients move from pre-op to OR, or OR to PACU, everyone should know exactly what’s expected. Simple checklists for readiness, timeouts, and supply verification can cut down on missed steps.
Next, give the team visibility. Even a basic live board showing which room is ready, which patient is prepped, and where the surgeon is can prevent idle time and miscommunication.
Don’t forget referrals. When complex cases have to be sent out, the packet of information should be complete the first time, including medications, vitals, allergies, and anesthesia assessments. Building it directly from the perioperative record avoids retyping and reduces back-and-forth with outside hospitals.
Finally, keep it simple on metrics. Pick five that matter: turnover averages, on-time starts, unplanned returns to OR, referral leakage, and patient throughput. Review them monthly, share them with the team, and act quickly when the numbers show a problem.
Ultimately, the roadmap isn’t about shiny technology. It’s about making sure the people on the ground—nurses, surgeons, techs have a clear path and the right tools to keep patients moving safely through the system.
The Bottom Line
IHS surgical programs operate under harsh financial conditions and serve patients who often travel long distances for care. Improving workflows isn’t about chasing the latest technology; it’s about freeing up staff time, preventing cancellations, and ensuring patients don’t fall through the cracks.
Tools built for perioperative coordination, like those used extensively in the VA and other government systems, can help IHS facilities do more with the resources they already have.
As one surgical nurse summed it up:
“Every turnover we save is one more patient from our community who doesn’t have to drive to another city. That’s what matters most.”
About the Author
Theresa Sullivan serves as the Director of Government Sales at Picis, where she leverages over 19 years of experience in facilitating successful perioperative software implementations for the Veterans Administration as well as other Government Departments. With extensive knowledge of perioperative workflows and healthcare information technology, she is dedicated to assisting hospitals in enhancing patient safety and optimizing documentation through integrated, specialty-focused clinical software solutions.
References
- U.S. Government Accountability Office (GAO). Indian Health Service: Actions Needed to Improve Oversight of Provider Misconduct and Substandard Care. GAO-19-74R. December 2018. https://www.gao.gov/products/gao-19-74r
- Mercatus Center. Increasing Funding for the Indian Health Service to Improve Native American Health. Policy Brief, 2018. https://www.mercatus.org/research/policy-briefs/increasing-funding-indian-health-service-improve-native-american-health
- National Council of Urban Indian Health (NCUIH). Comparison of the Veteran Health Administration and IHS Facilities Funding. 2022. https://ncuih.org/2022/04/15/resource-comparison-of-the-veteran-health-administration-and-ihs-facilities-funding-document-released-on-ncuih-website/
- Center for Health Care Strategies (CHCS). Strengthening Medicaid and Tribal Relationships to Better Support Native Populations. 2023. https://www.chcs.org/strengthening-medicaid-and-tribal-relationships-to-better-support-native-populations/
- Indian Health Service (IHS). Overview and Services. https://www.ihs.gov/
- Wikipedia. Indian Health Service. https://en.wikipedia.org/wiki/Indian_Health_Service
- Picis. Government Suite Solutions. https://www.picis.com/solution/government-suite/
- U.S. Department of Veterans Affairs, Office of Information and Technology (OIT). Technical Reference Model (TRM). https://www.oit.va.gov/Services/TRM/
